Early postoperative cognitive dysfunction after simultaneous coronary artery bypass grafting and carotid endarterectomy

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
O Maleva ◽  
I Syrova ◽  
O Trubnikova ◽  
O Barbarash
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Postoperative Period ◽  
Artery Bypass ◽  
Postoperative Cognitive Dysfunction ◽  
Early Postoperative Period ◽  
Cognitive Status ◽  
Funding Source ◽  
Bypass Grafting ◽  
The Mean

Abstract Purpose To assess cognitive status after simultaneous coronary artery bypass grafting (CABG) and carotid endarterectomy (CEE). Material & methods. Changes in cognitive status and the incidence of POCD were evaluated in the early postoperative period after simultaneous CABG and CEE. 53 patients with polyvascular disease (PolyVD) undergoing CABG and CEE were included in the study. Patients were assigned to two groups. 25 patients without mild cognitive impairment (MCI), the mean age of 64.3±7.9 years, were included in Group 1 and 28 patients with MCI, the mean age of 65.3±6.75 years, were included in Group 2. Neuropsychological testing was performed on days 2 before surgery and on days 7 after surgery using the psycho-physiological testing software “Status PF”. Attention was assessed with the Bourdon's test or proofreading test. Memory was estimated with the 10 numbers memorizing test, 10 words memorizing test, and 10 syllables memorizing test. The assessment of neurodynamics included the measurement of the complex visual-motor reaction time (VMRT), brain performance (BP), and functional mobility of the nervous processes (FMNP). The presence of POCD was estimated as a 20% decline on 20% of the tests. A reference range for neuropsychological indicators (13 indicators of the test battery) was set at the intervals corresponding to the ranges between the quartiles [Q25; Q75] in healthy people. Thus, cognitive status scale includes low cognitive status with the values ranging from 0 to 0.34, below the average - from 0.35 to 0.51, the average - from 0.52 to 0.7, and high cognitive status >0.7 to 1.0. Early postoperative cognitive dysfunction (POCD) was diagnosed as a 20% decline in memory, attention, and neurodynamics from the baseline on 20% of the tests passed. Statistical analysis was performed using the “Advanced” software package. Results At baseline, cognitive status in patients without MCI was below the average (0.38±0.2), whereas in MCI patients it was lower by 32% and corresponded to low (0.26±0.1; p=0.03). Cognitive status did not differ significantly between both groups in the postoperative period, but a trend towards its decrease was determined (0.34±0.2 vs. 0.27±0.13, p>0.5). However, the incidence of early POCD in patients without MCI was 14 (56%), and in patients with MCI - 20 (71%) patients. Conclusion At baseline, patients with PolyVD, regardless of the presence of MCI, according to the results of the comprehensive examination, showed low and below the average cognitive status. Simultaneous CABG and CEE does not prevent the deterioration of cognitive functions in patients with PolyVD in the early postoperative period. Patients with PolyVD undergoing myocardial and brain revascularization have a high risk of worsening cognitive disorders and need to individual approach to make a reasonable choice of the optimal surgical strategy. Funding Acknowledgement Type of funding source: Public hospital(s). Main funding source(s): Institute

Frailty syndrome as an independent predictor of unfavorable outcome in patients undergoing coronary artery bypass grafting

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
K Krivoshapova ◽  
O.L Barbarash ◽  
E.A Wegner ◽  
N.A Terentyeva ◽  
I.I Grigorieva ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Postoperative Period ◽  
Artery Bypass ◽  
Early Postoperative Period ◽  
Bypass Grafting ◽  
Artery Bypass Grafting ◽  
Risk Of Death

Abstract Purpose To assess the prevalence of frailty in the preoperative period and to evaluate its effect on the risk of complications and adverse outcomes in patients undergoing coronary artery bypass grafting (CABG). Methods 303 patients undergoing preoperative management for elective primary CABG were recruited in the study. The study cohort was divided into three groups depending on the PRISMA-7 scores suggesting the presence or absence of frailty and the presence of prefrailty. Statistical analysis was performed using the commercially available software package STATISTICA 8.0.360.0 for Windows (StatSoft, Inc., USA) and SPSS Statistics v. 17.0.0. Results 46 (15%) patients had frailty, while 49 (16%) patients were diagnosed with prefrailty. 208 (69%) patients did not have any signs of frailty. All three groups had significant age differences, therefore only elderly patients aged of 67.0±6.5 years with frailty were allocated for subsequent analysis (prefrailty group - 62.3±7.4 years old, patients without frailty - 60.0±7.7 years, p=0.003). Patients with frailty or prefrailty more often suffered from diabetes mellitus (patients without frailty - 19.2%, prefrailty group - 30.6% and frailty group - 28.3%, p=0.05), arterial hypertension (69.2%, 93.9% and 95.7%, respectively, p<0.001), atrial fibrillation or flutter (7.2%, 14.3% and 19.6%, respectively, p=0.03), chronic heart failure class 3–4 (7.2%, 10.2% and 8.7%, respectively, p=0.002), and peripheral arterial disease (22.6%, 38.8% and 58.7%, respectively, p<0.001). Three groups were comparable in main clinical and demographic parameters. There were no significant differences found in the incidence of postoperative atrial fibrillation or flutter (15.9%, 8.2% and 6.5%, respectively, p=0.07) and infections (1.9%, 0% and 4.3%, respectively, p=0.640). The incidence of myocardial infarction in the intra- and early postoperative period after CABG did not differ significantly between the groups (0.5%, 2% and 0%, respectively, p=0.328) as well as the incidence of stroke (2.4%, 2% and 0%, respectively, p=0.640). Patients with frailty and prefrailty had significantly higher cerebrovascular and cardiovascular mortality compared to those without frailty (8.2%, 2.2% and 0.5%, respectively, p=0.001). Conclusion Almost 15% of patients referred to CABG suffered from frailty. The presence of prefrailty or frailty increases the risk of death in the early postoperative period after CABG. Funding Acknowledgement Type of funding source: None

scholarly journals Right ventricle contractility during early postoperative period after coronary artery bypass grafting with cardiopulmonary bypass

2015 ◽  
Vol 18 (3) ◽  
pp. 34
Author(s):  
A. Ye. Bautin ◽  
A. P. Mikhaylov ◽  
D. A. Laletin ◽  
V. Ye. Rubinchik
Keyword(s):  
Cardiopulmonary Bypass ◽  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Right Ventricle ◽  
Postoperative Period ◽  
Artery Bypass ◽  
Early Postoperative Period ◽  
Inotropic Support ◽  
Bypass Grafting ◽  
The Right

Emphasis in this research was placed on contractility of the right ventricle with regard to its relationship with systemic hemodynamics in patients undergoing coronary artery bypass grafting (CABG) under cardiopulmonary bypass (CPB). The study included 25 patients (14 males, 11 females, mean age was 587 years) admitted to ICU after CABG under CPB. All patients required inotropic therapy. The criterion for prescribing inotropic support in the postoperative period was a drop of the stroke volume index of the left ventricle below 35 ml/m <sup>2</sup> provided that the values of this indicator were normal before the perfusion period. Patients with previous pathology of the right ventricle or right coronary artery were excluded from the study. To evaluate the right ventricular function and systemic hemodynamics indicators, use was made of the PiCCO plus system and VoLEF addon device. It was found out that reduced contractility of the right ventricle may cause the reduction in stroke volume of the left ventricle with normal contractility. It was also observed that the increase of preload in patients with right ventricular ejection fraction less than 30% does not improve its function but leads to the increase of its end-diastolic volume. In 68% of cases, the need in inotropic agents in the early postoperative period after CABG was associated with the drop in right ventricle contractility, in 40% - with isolated right ven-tricular dysfunction. Patients with isolated reduction in right ventricle contractility required a longer period of inotropic support and ICU stay as compared with those with left ventricular failure.

scholarly journals Bilateral internal thoracic artery coronary bypass grafting

2019 ◽  
Vol 178 (3) ◽  
pp. 10-15
Author(s):  
D. V. Kuznetsov ◽  
A. A. Gevorgyan ◽  
V. V. Novokshenov ◽  
K. M. Mikhailov ◽  
A. V. Kryukov ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Hospital Mortality ◽  
Coronary Artery Bypass ◽  
Postoperative Period ◽  
Artery Bypass ◽  
Coronary Bypass ◽  
Early Postoperative Period ◽  
Bypass Grafting ◽  
Group 1

The OBJECTIVE of the study was to assess the immediate results of the use of two internal thoracic arteries during coronary bypass surgery.MATERIAL AND METHODS. 200 patients with coronary artery disease underwent coronary artery bypass grafting in Samara cardiology dispensary from 2016 to 2018. Patients were divided into 2 groups. Group 1 (100 people) used both internal thoracic arteries (ITA) and the radial artery as conduits; group 2 (100 people) used the left ITA and the great saphenous vein as conduits. The duration of the operation, complications in the early postoperative period, and hospital mortality were evaluated.RESULTS. Groups (1 – 73 % of men, average age (59±12) years, average number of conduits – (3.1±0.4), 2 – 62 % of men, average age (67±7) years, average number of conduits – (3.3±0.6)) were significantly different only in age. The average duration of the operation in the group 1 was (174±25) min, in 2 – (165±18) min (p<0.05). Hospital mortality in the group 1 – 0 %, in 2 – 1 % (p>0.05). The number of complications in the early postoperative period did not have a statistically significant difference between the groups.CONCLUSION. Bilateral internal thoracic arteries coronary artery bypass grafting in CHD patients did not lead to a significant increase in the duration of the operation, an increase in mortality and infectious  complications from the sternum, compared with single internal thoracic arteries grafting.

scholarly journals Risk factors of acute cerebral circulatory disorder in the early postoperative period after coronary artery bypass grafting

2018 ◽  
pp. 41-45
Author(s):  
E. N. Danilevskaya ◽  
N. A. Ioffe
Keyword(s):  
Risk Factors ◽  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Postoperative Period ◽  
Artery Bypass ◽  
Early Postoperative Period ◽  
Bypass Grafting ◽  
Artery Bypass Grafting ◽  
Circulatory Disorder

This publication is devoted to the problem of occurrence of acute cerebral circulatory disorder (STROKE) in operated patients as the most severe type of cerebral dysfunction that increases mortality and leads to patients’ disability, aggravating results of cardiosurgery treatment. The aim of our work was to determine the frequency, types, predictors of the risk of STROKE after coronary artery bypass grafting. The study included 844 patients who were operated in the National Amosov Institute of Cardiovascular Surgery of NAMS of Ukraine, Kyiv. Findings and conclusions. The incidence of acute disorders of cerebral circulation in the early postoperative period was 1.4 % (n = 12). In the structure of all strokes the STROKE of ischemic type were recorded at 83.3 % (n = 10) and that was the most frequent type of acute cerebral circulatory disorder (ACCD) in the early postoperative period. The most important risk factors for STROKE in the early postoperative period are: radionecrosis of the carotid arteries > 50 %, aortic atherosclerosis, atrial fibrillation in postoperative period, performing operations under extracorporeal circulation. All patients at high risk of the emergence of ACCD require careful assessment of the state of the aorta and carotid vessels before operation, improvement of surgical technique and the postoperative period according to the corresponding risk factors identified.

scholarly journals Frailty syndrome as an independent predictor of unfavorable outcome in patients undergoing coronary artery bypass grafting

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
K E Krivoshapova ◽  
O L G A Barbarash ◽  
V L Masenko ◽  
A N Kokov ◽  
N A Terentyeva
Keyword(s):  
Atrial Fibrillation ◽  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Postoperative Period ◽  
Artery Bypass ◽  
Early Postoperative Period ◽  
Postoperative Treatment ◽  
Bypass Grafting ◽  
Artery Bypass Grafting

Abstract Purpose To assess the prevalence of frailty in the preoperative period and to evaluate its effect on the risk of complications and adverse outcomes in patients undergoing coronary artery bypass grafting (CABG). Methods 387 patients undergoing preoperative management for elective primary CABG were recruited in the study. The study cohort was divided into three groups depending on the “Age is no disqualification” scores suggesting the presence or absence of frailty and the presence of prefrailty. Demographic and clinical data were collected for each patient, including surgery data, pre- and postoperative treatment, intra- and postoperative complications and outcomes of CABG. Statistical analysis was performed using the commercially available software package IBM SPSS Statistics 26.0.0. Results 74 (19%) patients had frailty, while 225 (58%) patients were diagnosed with prefrailty and 88 (23%) patients did not have any signs of frailty. All three groups had significant age differences, patients without frailty – 56 [63–67] years old, prefrailty group – 59 [65–69] years old, patients with frailty – 62 [66–72] years old, p=0,003. Patients with frailty or prefrailty more often suffered from diabetes mellitus (patients without frailty – 14,8%, prefrailty group – 25,8% and frailty group – 36,5%, p=0,006), atrial fibrillation or flutter (16,7%, 14,3% and 35,6%, respectively, p=0,05) and cerebral atherosclerosis (45,5%, 62,2% and 60,8%, respectively, p=0,02). Three groups were comparable in main clinical and demographic parameters. There were no significant differences found in the incidence of infections (3,4%, 2,2% and 4%, respectively, p=0,655) and haemorrhagic complications (1,2%, 1% and 0,5%, respectively, p=0,680). Patients with frailty or prefrailty in the intra- and early postoperative period after CABG had significantly higher incidence of low output syndrome (1,2%, 7,6% and 13,5%, respectively, p=0,01, OR 8,5, 95% CI, 1,1–63,5) and postoperative atrial fibrillation or flutter (5,7%, 16% and 12,2%, respectively, p=0,04, OR 2,9, 95% CI, 1,1–7,5). The incidence of myocardial infarction in the intra- and early postoperative period after CABG did not differ significantly between the groups (0%, 0,5% and 1,5%, respectively, p=0,476) as well as the incidence of stroke (2,3%, 1,8% and 4,1%, respectively, p=0,523). Patients with frailty and prefrailty had significantly higher cerebrovascular and cardiovascular mortality compared to those without frailty (1%, 0% and 5,4%, respectively, p=0,04, OR 2,6, 95% CI, 1,1–5,9). Conclusion Almost 19% of patients referred to CABG suffered from frailty. The presence of prefrailty or frailty increases the risk of death in the early postoperative period after CABG. FUNDunding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): Federal State Budgetary Institution “Research Institute for Complex Issues of Cardiovascular Diseases”, Kemerovo, Russian Federation

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